eMedicine Specialties > Infectious Diseases > Bacterial Infections
Listeria Monocytogenes: Treatment & Medication
Updated: Jun 23, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Intravenous antibiotics must be started immediately when the diagnosis is suspected or confirmed.
- Diagnosis is established by culture of the organism from blood, CSF, or other sterile body fluid.
- Person-to-person transmission does not occur; therefore, isolation precautions are not necessary.
Consultations
Listeriosis may be sporadic or may be part of a larger epidemic. The table below lists some of the most recent epidemics. Consultation with an infectious disease specialist or an epidemiologist is important when epidemic listeriosis is suspected.
Epidemic Listeriosis
Open table in new window
Table
Location | Source | |
| 2007 | Massachusetts | Milk |
| 2003 | United Kingdom | Sandwiches |
| 2002 11 | United States (nationwide) | Delicatessen turkey breast |
| August 1998 to January 1999 | Multiple states in the United States | Hot dogs, deli meats |
| 1997 2 | Italy | Corn |
| 1997 12 | Sweden | Rainbow trout |
| 1995 13 | Switzerland | Soft cheese |
| 1994 14 | Illinois | Chocolate milk |
| 1992 15 | France | Rillettes (pork product) |
| 1985 16 | California | Mexican-style soft cheese |
| 1983 17 | New England | Unpasteurized milk |
| 1981 18 | Canada | Coleslaw |
Location | Source | |
| 2007 | Massachusetts | Milk |
| 2003 | United Kingdom | Sandwiches |
| 2002 11 | United States (nationwide) | Delicatessen turkey breast |
| August 1998 to January 1999 | Multiple states in the United States | Hot dogs, deli meats |
| 1997 2 | Italy | Corn |
| 1997 12 | Sweden | Rainbow trout |
| 1995 13 | Switzerland | Soft cheese |
| 1994 14 | Illinois | Chocolate milk |
| 1992 15 | France | Rillettes (pork product) |
| 1985 16 | California | Mexican-style soft cheese |
| 1983 17 | New England | Unpasteurized milk |
| 1981 18 | Canada | Coleslaw |
Medication
Antibiotic therapy is the treatment of choice. Bacteremia should be treated for 2 weeks if the patient is immunocompetent. Longer courses may be required in the immunocompromised patient. Meningitis should be treated for 3 weeks; endocarditis, for 4-6 weeks; and brain abscess, for at least 6 weeks. Ampicillin is generally considered the preferred agent, but other agents may be acceptable. Gentamicin is added frequently for synergy, but it may be discontinued after 1 week of clinical improvement in order to decrease the chance of renal toxicity or ototoxicity.19
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Ampicillin (Omnipen, Marcillin)
DOC. Interferes with bacterial cell wall synthesis during active multiplication, causing bactericidal activity against susceptible organisms.
Adult
2 g IV q4h
Pediatric
200-400 mg/kg/d IV divided q4h
Probenecid and disulfiram decrease renal excretion of ampicillin, causing an increase in levels; conversely, allopurinol increases excretion and has an additive effect on ampicillin rash; may decrease effect of oral contraceptives
Documented hypersensitivity (also to other penicillins)
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Dose adjustments may be necessary in renal failure; appearance of rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction
Trimethoprim-sulfamethoxazole (Bactrim)
Indicated for patients unable to take penicillin antibiotics. Inhibits bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid, which results in inhibition of bacterial growth.
Adult
20 mg/kg/d of trimethoprim IV divided q6h
Pediatric
Administer as in adults
May increase prothrombin time of warfarin, monitor coagulation tests and adjust dose prn; serum levels of dapsone and TMP may increase when administered concomitantly; incidence of thrombocytopenia purpura may increase when used concurrently with diuretics in elderly patients; hepatic clearance of phenytoin may be decreased and half-life prolonged when administered concurrently; sulfonamides can displace methotrexate (MTX) from plasma protein-binding sites, thus increasing free MTX concentrations; this may potentiate MTX effects in bone marrow depression; hypoglycemic response of sulfonylureas may be increased with concurrent administration of both medications; may decrease renal clearance of zidovudine, causing an increase in zidovudine levels
Documented hypersensitivity; megaloblastic anemia due to folate deficiency; infants <2 mo
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs CBC count frequently; if significant reduction of any formed blood element is noted, discontinue therapy; goiter production, diuresis, and hypoglycemia may occur; high IV doses or prolonged infusions may cause bone marrow depression manifested as thrombocytopenia, leukopenia, or megaloblastic anemia
Exercise caution in patients with possible folate deficiency (eg, chronic alcoholism, elderly, anticonvulsant therapy, malabsorption syndrome)
Hemolysis may occur in G-6-PD deficiency; if signs of bone marrow depression occur, give leucovorin prn to restore normal hematopoiesis; oral leucovorin (5-15 mg/d) has been recommended; because of their unique immune dysfunction, patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment; administer adequate fluid to prevent crystalluria and stone formation; perform urinalyses and renal function tests during therapy
Chloramphenicol (Chloromycetin)
Binds to 50 S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.
Adult
50-100 mg/kg/d PO/IV divided q6h for 10 d; not to exceed 4 g/d
Pediatric
50-75 mg/kg/d PO/IV divided q6h
Administered concurrently with barbiturates, levels may decrease while barbiturate levels may increase, causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Use only for indicated infections or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (eg, aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (gray syndrome)
More on Listeria Monocytogenes |
| Overview: Listeria Monocytogenes |
| Differential Diagnoses & Workup: Listeria Monocytogenes |
 Treatment & Medication: Listeria Monocytogenes |
| Follow-up: Listeria Monocytogenes |
| References |
| « Previous Page | Next Page » |
References
Ooi ST, Lorber B. Gastroenteritis due to Listeria monocytogenes. Clin Infect Dis. May 1 2005;40(9):1327-32. [Medline].
Aureli P, Fiorucci GC, Caroli D, Marchiaro G, Novara O, Leone L, et al. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. N Engl J Med. Apr 27 2000;342(17):1236-41. [Medline].
Pappas G, Panagopoulou P, Christou L, Akritidis N. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect Dis Clin North Am. Jun 2006;20(2):395-421, x. [Medline].
Mylonakis E, Paliou M, Hohmann EL, Calderwood SB, Wing EJ. Listeriosis during pregnancy: a case series and review of 222 cases. Medicine (Baltimore). Jul 2002;81(4):260-9. [Medline].
Sheffield JS. Sepsis and septic shock in pregnancy. Crit Care Clin. Oct 2004;20(4):651-60; viii. [Medline].
Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore). Sep 1998;77(5):313-36. [Medline].
Armstrong RW, Fung PC. Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin Infect Dis. May 1993;16(5):689-702. [Medline].
Josephson SA, Pillai DR, Phillips JJ, Chou D. Neurolisteriosis presenting as cervical myelitis in an immunocompetent patient. Neurology. Apr 11 2006;66(7):1122-3. [Medline].
Dee RR, Lorber B. Brain abscess due to Listeria monocytogenes: case report and literature review. Rev Infect Dis. Nov-Dec 1986;8(6):968-77. [Medline].
Faidas A, Shepard DL, Lim J, Nelson JE, Baddour LM. Magnetic resonance imaging in listerial brain stem encephalitis. Clin Infect Dis. Jan 1993;16(1):186-7. [Medline].
Gottlieb SL, Newbern EC, Griffin PM, Graves LM, Hoekstra RM, Baker NL, et al. Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis. Jan 1 2006;42(1):29-36. [Medline].
Ericsson H, Eklöw A, Danielsson-Tham ML, Loncarevic S, Mentzing LO, et al. An outbreak of listeriosis suspected to have been caused by rainbow trout. J Clin Microbiol. Nov 1997;35(11):2904-7. [Medline].
Büla CJ, Bille J, Glauser MP. An epidemic of food-borne listeriosis in western Switzerland: description of 57 cases involving adults. Clin Infect Dis. Jan 1995;20(1):66-72. [Medline].
Dalton CB, Austin CC, Sobel J, Hayes PS, Bibb WF, Graves LM, et al. An outbreak of gastroenteritis and fever due to Listeria monocytogenes in milk. N Engl J Med. Jan 9 1997;336(2):100-5. [Medline].
Goulet V, Rocourt J, Rebiere I, Jacquet C, Moyse C, Dehaumont P, et al. Listeriosis outbreak associated with the consumption of rillettes in France in 1993. J Infect Dis. Jan 1998;177(1):155-60. [Medline].
Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C, et al. Epidemic listeriosis associated with Mexican-style cheese. N Engl J Med. Sep 29 1988;319(13):823-8. [Medline].
Schlech WF 3rd, Lavigne PM, Bortolussi RA, Allen AC, Haldane EV, Wort AJ, et al. Epidemic listeriosis--evidence for transmission by food. N Engl J Med. Jan 27 1983;308(4):203-6. [Medline].
Evans JR, Allen AC, Stinson DA, Bortolussi R, Peddle LJ. Perinatal listeriosis: report of an outbreak. Pediatr Infect Dis. May-Jun 1985;4(3):237-41. [Medline].
Lorber B. Listeriosis. Clin Infect Dis. Jan 1997;24(1):1-9; quiz 10-1. [Medline].
Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, MI: Physicians Press; 2008.
Armstrong D, Cohen J, eds. Listeria Monocytogenes. In: Infectious Diseases. London, UK: Mosby; 1999:8.15.1-8.15.20.
Berenguer J, Solera J, Diaz MD, Moreno S, Lopez-Herce JA, Bouza E. Listeriosis in patients infected with human immunodeficiency virus. Rev Infect Dis. Jan-Feb 1991;13(1):115-9. [Medline].
Blatt SP, Zajac RA. Treatment of Listeria bacteremia with vancomycin. Rev Infect Dis. Jan-Feb 1991;13(1):181-2. [Medline].
Broome CV. Listeriosis: Can we prevent it?. ASM News. 1993;59:444-6.
Calubiran OV, Horiuchi J, Klein NC, Cunha BA. Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis. Heart Lung. Jan 1990;19(1):21-3. [Medline].
Chang J, Powles R, Mehta J, Paton N, Treleaven J, Jameson B. Listeriosis in bone marrow transplant recipients: incidence, clinical features, and treatment. Clin Infect Dis. Nov 1995;21(5):1289-90. [Medline].
Charpentier E, Gerbaud G, Jacquet C, Rocourt J, Courvalin P. Incidence of antibiotic resistance in Listeria species. J Infect Dis. Jul 1995;172(1):277-81. [Medline].
Cherubin CE, Appleman MD, Heseltine PN, Khayr W, Stratton CW. Epidemiological spectrum and current treatment of listeriosis. Rev Infect Dis. Nov-Dec 1991;13(6):1108-14. [Medline].
Cunha BA. Central nervous system infections in the compromised host: a diagnostic approach. Infect Dis Clin North Am. Jun 2001;15(2):567-90. [Medline].
Cunha BA, Fatehpuria R, Eisenstein LE. Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: the differential diagnostic importance of cerebrospinal fluid lactic acid levels. Heart Lung. May-Jun 2007;36(3):226-31. [Medline].
Cunha BA, Filozov A, Remé P. Listeria monocytogenes encephalitis mimicking West Nile encephalitis. Heart Lung. Jan-Feb 2004;33(1):61-4. [Medline].
Decker CF, Simon GL, DiGioia RA, Tuazon CU. Listeria monocytogenes infections in patients with AIDS: report of five cases and review. Rev Infect Dis. May-Jun 1991;13(3):413-7. [Medline].
Farber JM, Peterkin PI. Listeria monocytogenes, a food-borne pathogen. Microbiol Rev. Sep 1991;55(3):476-511. [Medline].
Gellin BG, Broome CV, Bibb WF, Weaver RE, Gaventa S, Mascola L. The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group. Am J Epidemiol. Feb 15 1991;133(4):392-401. [Medline].
Gorbach SL, Bartlett JB, Blacklow NR, eds. Listeria Monocytogenes. In: Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:1750-5.
Gross E, Slauson S. Update on emerging infections: news from the Centers for Disease Control and Prevention. Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003. Ann Emerg Med. Nov 2004;44(5):532-6. [Medline].
Hof H, Nichterlein T, Kretschmar M. Management of listeriosis. Clin Microbiol Rev. Apr 1997;10(2):345-57. [Medline].
John JF. Listeria Monocytogenes. In: Vinken PJ, Bruyn GW, eds. Handbook of ClinicalNeurology. Vol 8. New York, NY: Elsevier Science; 1988:89-101.
Klein NC, Schoch PE, Cunha BA. Listeria. Infect Control Hosp Epidemiol. May 1991;12(5):311-4. [Medline].
Latcha S, Cunha BA. Listeria monocytogenes meningoencephalitis: the diagnostic importance of the CSF lactic acid. Heart Lung. Mar-Apr 1994;23(2):177-9. [Medline].
Lorber B. Listeria Monocytogenes. In: Mandell GL, Bennett GE, Dolin R, eds. Principles and Practices of Infectious Diseases. 6th ed. Pennsylvania, PA: Churchill and Livingstone; 2005:2478.
Pigrau C, Almirante B, Pahissa A, Gasser I, Martinez Vasquez JM. Clinical presentation and outcome in cases of listeriosis. Clin Infect Dis. Jul 1993;17(1):143-4. [Medline].
Pinner RW, Schuchat A, Swaminathan B, Hayes PS, Deaver KA, Weaver RE, et al. Role of foods in sporadic listeriosis. II. Microbiologic and epidemiologic investigation. The Listeria Study Group. JAMA. Apr 15 1992;267(15):2046-50. [Medline].
Riedo FX, Pinner RW, Tosca ML, Cartter ML, Graves LM, Reeves MW, et al. A point-source foodborne listeriosis outbreak: documented incubation period and possible mild illness. J Infect Dis. Sep 1994;170(3):693-6. [Medline].
Schneider JI. Rapid infectious killers. Emerg Med Clin North Am. Nov 2004;22(4):1099-115. [Medline].
Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med. Oct 2 1997;337(14):970-6. [Medline].
Skogberg K, Syrjanen J, Jahkola M, Renkonen OV, Paavonen J, Ahonen J, et al. Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy. Clin Infect Dis. Apr 1992;14(4):815-21. [Medline].
Spitzer PG, Hammer SM, Karchmer AW. Treatment of Listeria monocytogenes infection with trimethoprim-sulfamethoxazole: case report and review of the literature. Rev Infect Dis. May-Jun 1986;8(3):427-30. [Medline].
Swaminathan B, Rocourt J, Bille J. Listeria. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995:341-8.
Taege AJ. Listeriosis: recognizing it, treating it, preventing it. Cleve Clin J Med. Jun 1999;66(6):375-80. [Medline].
Tappero JW, Schuchat A, Deaver KA. Reduction in the incidence of human listeriosis in the United States. Effectiveness of prevention efforts? The Listeriosis Study Group. JAMA. Apr 12 1995;273(14):1118-22. [Medline].
Uldry PA, Kuntzer T, Bogousslavsky J, Regli F, Miklossy J, Bille J, et al. Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases. J Neurol. 1993;240(4):235-42. [Medline].
Walsh RD, Gurevich I, Cunha BA. Listeria: A potential cause of febrile transfusion reactions. J Hosp Infect. 1993;18:81-82.
Further Reading
Keywords
Listeria monocytogenes, L monocytogenes, diarrhea, listeriosis, epidemic gastroenteritis, bacteremia, meningitis, CNS infection, meningoencephalitis, endocarditis, septic arthritis, osteomyelitis, pneumonia, corticosteroid therapy
